Strategies for Promoting the Scientific Integrity of Nursing Research in Clinical Settings
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JNSD Journal for Nurses in Staff Development & Volume 26, Number 5, 200Y205 & Copyright B 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Strategies for Promoting the Scientific Integrity of Nursing Research in Clinical Settings Roseann Barrett, PhD, RN Magnet hospitals were surveyed to determine the processes designation is given to healthcare organizations that em- used to promote the integrity of nursing research conducted in body nursing excellence. Hospitals that have achieved clinical settings. Results indicated that four central processes, Magnet designation must be able to demonstrate the pres- institutional review board review, nursing research council ence of well-established and operationalized structures review, nursing research mentorship, and reliance on and processes for research and evidence-based prac- personal and professional values, were used to educate, tice (American Nurses Credentialing Center, 2007a). It monitor, and oversee the integrity of research conducted by is hoped that, by understanding the processes currently bedside nurse scientists. Staff development educators are being used by these institutions, strategies may be identi- challenged to provide instruction regarding the process of fied that may contribute to the development of a proactive nursing research and all elements of scientific integrity. and consistent framework by which to ensure the scien- Research is needed to test the effectiveness of the processes tific integrity of the nursing research conducted in clinical identified in this investigation in promoting the quality and settings. The research question that was answered by this integrity of nursing research conducted in clinical settings. investigation is, “How is scientific integrity in nursing re- search promoted in Magnet hospitals?” esearch is an essential component in profes- REVIEW OF THE LITERATURE sional nursing practice. Ketefian (2001) suggested Lenz and Ketefian (1995) suggested that “externally im- R that the pace and growth of nursing research has posed rules and regulations, rather than internalized been faster than that of the understanding of ethical issues ethics, integrity and informal norms regarding personal and social considerations that are of paramount importance and professional responsibility seem to take precedence in the conduct of science. Understanding scientific integrity as the arbiters of science” (p. 213). Guidelines for the ethi- and the factors that influence researchers to adhere to ethical cal conduct of research involving human subjects have standards is critical to the protection of human subjects in been developed by various federal and private agencies. nursing research and to the advancement of nursing science Research involving human subjects must undergo an ethi- (Jeffers, 2005). The conduct of nursing research is no longer cal review by an institutional review board (IRB) to ensure , limited to academic settings; the most useful patient care re- that the participants rights as research participants are search is also conducted in clinical settings by bedside protected, just one aspect of promoting scientific integrity nurse scientists (Houser & Bokovoy, 2006). Although (Hueston et al., 2006). IRB review also involves assuring nursing research efforts in clinical settings have increased, compliance with federal regulations such as the Code there is little evidence of a consistent infrastructure to pro- of Federal Regulations, Title 45 and 21 (Department of mote an environment of nursing research integrity (Jeffers, Health and Human Services [DHHS], 2005). 2005; Newhouse & Mills, 2001). Two reports released by the Institute of Medicine The purpose of this investigation was to describe the (2002, 2003) focused on research integrity and the effec- current processes that are used in Magnet hospitals to pro- tiveness of IRBs. The reports proposed the importance mote the scientific integrity of nursing research. Magnet of the role of the research environment in promoting research integrity and recommended that institutions Roseann Barrett, PhD, RN, is Director of Nursing Research, Patient develop proactive organizational frameworks for the re- Care Services, St. Joseph Hospital, Nashua, New Hampshire. sponsible conduct of research. ADDRESS FOR CORRESPONDENCE: Roseann Barrett, 46 Fox Run, Guidelines for promoting scientific integrity involve Groton, MA 01450 (e-mail: barrettrb@charter.net). many elements and may vary by setting or discipline. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this educa- Discipline-specific guidelines for promoting the scientific tional activity. integrity of nursing research have been developed by the DOI: 10.1097/NND.0b013e31819b55dd Midwest Nursing Research Society (2002). The guidelines 200 www.jnsdonline.com September/October 2010 Copyright @ 2010 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. were developed to “promote the integrity of nursing science for institutional- and professional-level approaches to by integrating principles of science and ethics, and to en- promote scientific integrity. Responses from 38 schools hance the sense of social responsibility of scientists” (P.V.). indicated that, although information about misconduct The domains of nursing scientific integrity identified in the and scientific integrity was included in required research guidelines encompass several areas, including conflict of methods courses and optional workshops, the extent , interest, data stewardship and access, data management, and scope of instruction was variable. This study s find- collaboration, and publication practices, in addition to the ings indicated that a high value was placed on informal protection of the rights of human subjects in research. studentYmentor relationships as a means to socialize stu- A challenge faced by some bedside nurses conducting dents to the role of researcher. In addition, if they ex- research in clinical settings may be a rusty and unused re- isted, institutional guidelines for research integrity were search skill set (Houser & Bokovoy, 2006). To improve found to be more specific than were federal guidelines patient care by facilitating the conduct of evidence-based and focused primarily on handling misconduct rather practice and nursing research, some hospitals have estab- than promoting responsible science. The authors suggest lished nursing research centers or councils and employed the need for a more proactive and consistent approach nursing research consultants. The focus of these councils is to promoting scientific integrity. to provide structure, education, and mentorship about evi- The development of nursing knowledge through the dence-based practice and research fundamentals including conduct of research is essential to providing quality pa- terminology, research methods, and the research process tient care. Research practices may be influenced by in- (Hudson-Barr & King, 2004; Newhouse & Mills, 2001). ternal norms and external guidelines and may vary by The membership of nursing research councils may include institution, discipline, and research setting. After a review nurses with an interest in nursing research and who may of the literature, it may be suggested that there are cur- have varied educational preparation and research exper- rently no consistent or comprehensive processes for pro- tise. Most nurses in clinical practice may not have received moting the scientific integrity of nursing research information about scientific integrity or the role and re- conducted in clinical settings in place. sponsibilities of a nurse researcher during their education programs (Broome, 2003). Little is known about the ways METHODS in which bedside nurse scientists learn about scientific in- tegrity, the content of the information they receive, or the Research Design formal guidelines and informal norms that guide the con- A descriptive/exploratory design was used to describe duct of their investigations and related activities. the processes and strategies used in Magnet hospitals Jeffers (2005) proposed an internal control model for to promote the scientific integrity of nursing research. promoting an environment of research integrity. The model shifts attention from the behavior of the individual Sample researcher to examination of organizational control Because the study examined the processes and frame- processes within the research environment including in- works for promoting scientific integrity within clinical formation and communication, monitoring, control settings, the Magnet hospital rather than the individual activities, risk assessment, and control environment. The completing the survey was the unit of analysis. At the time author suggested that the model may be used as a frame- the study was conducted, there were 260 Magnet hospi- work to assess and evaluate research integrity at the tals in the United States and Australia (American Nurses organizational level to provide a “snapshot” of the quality Credentialing Center, 2007b). A representative from each and scientific integrity of the current nursing research envi- Magnet hospital was identified from a list of attendees at ronment. Testing the utility of the model in an academic the 2007 Magnet conference. Potential participants were setting is currently taking place (B. Jeffers, personal com- asked to forward the survey to the appropriate individual munication, February